F-QM-SAF-002-A-V0 — Daily Facility, Environment & Safety Check Log
Type: Form · Version: V0 · Status: DRAFT — UNAPPROVED · Served read-only from the bundled QMS copies. The Drive master is untouched.
Parent document: LAB-QM-SAF-002 — Facilities and Environmental Conditions (parent is encoded in the form number)
Rendered in-browser from the project's Word file F-QM-SAF-002-A-V0-daily-facility-environment-and-safety-check-log.docx (policies-docx / forms-docx — the file Junry reviews). Formatting is faithful, not pixel-perfect; the DOCX is the official copy.
| Document # | F-QM-SAF-002-A-V0 | Parent Document | LAB-QM-SAF-002 — Facilities and Environmental Conditions Policy |
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Part 1 — Operational Reference Standards & Allowable Ranges
Standard Allowable Limits:
- Clinical Laboratory Ambient Temperature:20.0 °C to 25.0 °C (Air conditioning continuous).
- Ambient Relative Humidity:30% to 65% RH (prevents reagent degradation & condensation).
- Emergency Eyewash Station: Weekly operational flush; path clear of obstructions; clean water stream.
- Utility Status: Water pressure adequate; municipal grid / generator standby operational; UPS battery indicators normal.
- Waste & Cleanliness: Yellow/Black bins lined; benches wiped with 1:100 (or 1:10) sodium hypochlorite at shift start and close.
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Part 2 — Daily Facility, Environmental & Safety Register (Monthly Sheet)
Month / Year: ________________ 2026 | Testing Area: Main Clinical Laboratory
| Day | Room Temp (°C) [20–25°C] | Relative Humidity (%) [30–65%] | Eyewash Station (Weekly Flush / Clear) | Water Supply & Sink Drains Normal? | Grid / UPS Power Normal? | Waste Segregation & Benches Clean? | Corrective Action if Out-of-Range | Duty MT / LA Initials |
|---|---|---|---|---|---|---|---|---|
| 1 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 2 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 3 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 4 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 5 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 6 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 7 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 8 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 9 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| 10 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No | ||||
| ... | ||||||||
| 31 | [ ] Pass [ ] NA | [ ] Yes [ ] No | [ ] Yes [ ] No | [ ] Yes [ ] No |
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Part 3 — Monthly Environmental & Safety Review Sign-Off
The Chief Medical Technologist / Laboratory Quality Manager reviews this log at the end of each calendar month.
| Review Parameter | Summary / Finding | Action Taken |
|---|---|---|
| Temperature Excursions (> 25°C or < 20°C): | Total Days: _____ | [ ] None [ ] AC service requested |
| Humidity Excursions (> 65% RH): | Total Days: _____ | [ ] None [ ] Dehumidification adjusted |
| Safety Eyewash Flushes Verified: | [ ] 4 of 4 Weeks Completed | [ ] Deficiency logged |
| Fire Extinguisher Pressure Checked: | [ ] In Green Zone Verified | [ ] Service tagged |
Reviewed by: Chief Medical Technologist: ________________________ Date: YYYY-MM-DD Noted by: Pathologist: _________________________________________ Date: YYYY-MM-DD